Greyscale and contrast enhanced ultrasonography for characterization of gastric malignant tumors.

AIMS: To evaluate the utility of grey scale ultrasonography (US) and contrast enhanced ultrasonography (CEUS) for characterization of malignant gastric tumors. MATERIAL AND METHODS: The study was conducted prospectively and it included a number of 30 patients with malignant gastric tumors diagnosed through upper tract endoscopy and biopsy: 25 adenocarcinomas, 3 lymphomas, and 2 stromal tumors. All the patients were examined by US, followed immediately by CEUS, using both oral and intravenous contrast agents. CEUS assessed the dynamics of the contrast agent during the arterial phase and the venous phase. The distribution characteristics of the contrast agent inside the region of interest (ROI) were also evaluated. Twenty four patients underwent surgery. RESULTS: Adenocarcinomas presented heterogeneous enhancement with variable pattern, followed by a delayed wash-out in almost all of the situations. Lymphomas presented a variable pattern, intensity and homogeneity of the enhancement, followed by delayed wash-out. Stromal tumors showed early arterial intense and homogenous enhancement followed by moderate wash-out in venous phase. CONCLUSIONS: Grey scale US and CEUS are useful methods in characterizing gastric tumors and contribute to a more adequate evaluation of the lesions. The dynamics of the contrast agent may be suggestive for the anatomopathological nature of the tumor. Larger studies will be necessary in order to determine thepractical value of the method.

Oral and I.V. contrast enhanced ultrasonography of the digestive tract--a useful completion of the B-mode examination: a literature review and an exhaustive illustration through images.

Contrast enhanced ultrasonography, using i.v. and/or oral/rectal contrast agents, represents a technical development of the US method, which has proved its applicability in the qualitative and quantitative assessment of the normal and pathological circulatory bed, as well as of the digestive lumen. The use of microbubbles and harmonics opens a new horizon in the detection and characterization of the inflammatory and tumoral conditions of the digestive tract. The interpretation of the data requires corroboration with the grey scale aspect of the examined lesion/area, as well as with the clinical context of the case and the results of other diagnosis techniques. The purpose of this paper is to review the main applications of CEUS in digestive tract pathology by analyzing the significant literature and guidelines in the light of our personal experience and demonstrating it through suggestive images.

The role of i.v. and oral contrast enhanced ultrasonography in the characterization of gastric tumors. A preliminary study.

OBJECTIVE: To identify the diagnosis benefits of harmonics optimized i.v. contrast enhanced ultrasonography (CEUS) in the detection and characterization of several gastric neoplasms. MATERIAL AND METHOD: The study group included 10 patients with gastric neoplasms, either epithelial or stromal. The examination included grey scale ultrasonography combined with hydrosonography and harmonics ultrasonography with i.v. contrast media, centered on the tumor, using the surrounding normal gastric wall as witness. All cases were examined by endoscopy, followed by a pathology report and eight of the patients underwent surgery. CEUS followed the dynamics of the contrast media during the arterial (up to 30 seconds since administration) and venous (30 to 60 seconds since administration) phases. The characteristics of contrast uptake in the region of interest were also studied. RESULTS: In gastric tumors an non-homogeneous uptake was registered during the arterial phase followed by contrast wash-out during the venous phase. In stromal tumors (GIST) there was an accelerated and uniform uptake in the arterial phase, while the wash-out was delayed. CEUS was able to show the masses in all cases. The aspect of the lesions on the grey scale images - infiltration of polyp - consolidated the diagnosis. CONCLUSIONS: The analysis of the cases included in the study proved that CEUS represents a promising method in the characterization of infiltrative and proliferative gastric tumors. The information must be combined with those obtained from the 2D harmonics ultrasound exam. Extended studies, on a higher number of cases, are necessary in order to demonstrate the practical use of the method.